The first clinic offering abortions on the island of Ireland opened its doors in the Northern Irish city of Belfast on Oct. 18, but the 400 pro-life protesters gathered outside were determined that no abortion procedures would happen there that day. Buses full of antiabortion demonstrators stood on the sidewalks carrying banners and placards outside the clinic, which is operated by Marie Stopes International, a U.K.-based organization that works worldwide providing reproductive- and sexual-health care services. “We knew we couldn’t sit back and live in a country where unborn babies were being violently destroyed every day,” says Bernadette Smyth, founder of Precious Life, a Northern Irish pro-life group, speaking after her organization’s participation in the protests. “The question of abortions is not a health issue, it’s a criminal one. Marie Stopes will be carrying out abortions illegally.”

Smyth’s claim is denied by the clinic. “Marie Stopes is operating completely in line with the current legal framework in Northern Ireland,” says a spokeswoman who requested that her name be withheld amid concerns for staff safety. “There’s a real need for a good sexual-health clinic in Northern Ireland. The clinic was able to open as planned, and we were pleased to receive thousands of messages of positive support from women and men telling us to stand tall against the protesters.” The spokeswoman declined to say whether any women have undergone abortions at the clinic.

An increasingly heated abortion debate, both in Northern Ireland and in the Republic of Ireland, is symptomatic of the island’s extraordinarily rapid transformation in recent decades. In the north, years of political strife and instability had slowed progress in areas of health and women’s rights; now peace, of a kind, is enabling social progress — with all the benefits and new tensions that brings. In the south, the Catholic Church held sway over the majority of political decisions through the 20th century; but a series of scandals involving the sexual abuse of children by priests has weakened an institution that was already facing challenges to its authority in a less reverential age. Prosperity during the economic-boom years also encouraged large numbers of women to pursue professional careers, which has inevitably led to smaller family sizes.

Nevertheless “the power and influence of the Catholic Church where it chooses to intervene in social-policy debates should not be underestimated in [the Republic of Ireland], where 84% still identify as Catholic,” says Ivana Bacik, a Senator for the Irish Labour Party, the junior member of the country’s governing coalition. Many leading members of the largest party in the Republic of Ireland’s government, Fine Gael, are devout Catholics, including Taoiseach (Prime Minister) Enda Kenny. Kenny said in an interview with TIME in September that he was personally against abortion. “I think that this issue is not of priority for government now,” he said. But the opening of the Belfast clinic isn’t the only reason he may have to revise that view.

The Republic of Ireland is one of a minority of four European states (the others are Malta, San Marino and Monaco) that still enforce highly restrictive criminal abortion laws. But, with approximately 4,000 women from the republic and 1,000 from the north traveling to Britain each year for abortions, the Irish electorate is increasingly calling for clarification of abortion legislation. If there is confusion over the legal status of abortion in Ireland, that’s hardly surprising. Northern Ireland never enacted the 1967 Abortion Act, which legalized abortion in the rest of the U.K. Northern Irish law states that women can have an abortion only if there is a long-term or permanent adverse risk to her physical or mental health. Even tougher strictures limit the availability of abortions in the Republic of Ireland, where a 1983 amendment to its constitution did seem to permit terminations but only if the mother’s life was in danger. This right has rarely been tested. There is no official legislation defining what the “risk of life to the mother” actually entails, and earlier laws prohibiting all abortions have never been repealed. Medical practitioners fear criminal and professional sanctions.

In 2010, the European Court of Human Rights upheld the case of a Lithuanian national living in the Republic of Ireland who argued that by denying her an abortion, the government had compromised her fundamental rights by putting her life at risk. She was recovering from a rare form of cancer when she became pregnant. In January 2012, the government set up a panel of experts to examine the European court’s ruling; their report is expected before the end of this year.

While the panel deliberated through the summer, pro-choice groups took to the streets calling for abortion laws to be changed. Meanwhile, pro-life groups plastered Dublin’s streets, buses and trams with shock-tactic posters. The Catholic Church has also made it clear that it will campaign against any liberalization of abortion in Ireland, both north and south of the border. It has set up a website and distributed leaflets to all 1,360 parishes urging Dublin to set aside a 1992 Supreme Court ruling that abortion should be allowed when the life of the mother is at risk. This isn’t the first time the subject of abortion has been so hotly debated.

In 1992, the Republic of Ireland hit the headlines in many countries with the story of a 14-year-old girl who was raped and became pregnant. The teenager, who became suicidal, was prevented from traveling to the U.K. for an abortion, but on appeal, the Attorney General in Dublin granted leave for the family to travel. Following the case, Dublin held a referendum on the right to abortion information and the right to travel abroad for an abortion; both measures received a majority yes vote from the electorate. The Supreme Court also ruled, in the wake of the X case appeal of the suicidal 14-year-old, that abortions would be allowed when there was a “real and substantial risk to the life, as distinct from the health, of the mother.” However, a Supreme Court ruling does not demand political action on behalf of the legislators, which means that successive governments have been able to ignore the law required to put this into effect.

Now the time for kicking the issue into the long grass may have passed. A poll carried out last year in the republic showed 54% of the country’s electorate backing the full legalization of abortion, up from 37% four years earlier. And, for the first time, women in the south contemplating unwanted pregnancies need only look north to see another option. The island has changed fast. Legislators and institutions on both sides of the border have some catching up to do.